Cranial Nerve Method of Testing Procedure Interpretation of results

I (Olfactory) Small Bottles 1. compress 1 nostril and
containing essences of sniff odor twice
very familiar odor are 2. ask whether he can
required. smell or identify odor
- Coffee 3. repeat test on other
- Lemon nostril and ask if smell is
- chocolate similar in both nostril
4. allow odor to disperse
and repeat test with
other 2 test odor, ask if
he can distinguish smell
- who can recognize and name odors quickly (
females)
- Who can recognize but difficulty in naming
(males)
- Who can smell and know difference but neither
recognize nor naming. – Above 3 should be
accepted as normal.
Parosmia – feel each odor is similar but is
distorted and unpleasant
Anosmia – can’t smell anything or is much
reduced compared to other.
Presbyosmia – Decreased sense of smell due to
aging
Phantosmia – perception of odor in absence –
medial temporal lobe seizure, psychosis

Cranial Nerve Method of Testing Procedure Interpretation of results

II Visual Acuity Confrontation Test Common cause:
Optic - Snellen’s chart 1. patient and examiner - Total unilateral loss of vision: optic
- Jaegers type sits to face. nerve lesion
card 2. pt. covers left eye and
Visual Field examiner at right eye
 - To chart 3. pt. moves the test - Homonymous hemianopia: lesion
periphery of object from outside the between optic tract to occipital
visual field visual field towards cortex
- To detect midline - Bitemporal hemianopia: lesion of
position, size 4. instruct the patient to optic chiasma
and shape of indicate appearance of
the blind spot the object

CN III Function: 1. Observation Analyzing nystagmus

Oculomotor - Controls the - presence and absence 1. watch patients eye while talking
external ocular of ptosis and squint 2. ask to look at a definite point and move the
CN IV muscles and - whether unilateral or point from left to right and up to down
Trochlear elevators of the bilateral 3. hold each end position for 5 seconds and
lids. - constant or variable assess nystagmus. ( direction, rate and
CN VI - Also regulates - size, shape, equality amplitude)
Abducent pupillary and regularity of the
muscles. pupils
Purpose of the test: 2. Reaction to light ( total paralysis of III, IV and VI nerve
- Inspect the - reduce illumination of indicated a lesion in cavernous sinus (carotid
pupils to rule room and vision should aneurism))
out a local focus on far objects
disease, - a bright beam of light is
peripheral shone from the side of
lesion or a one eye.
 nuclear - repeat on the other
involvement side ( the pupil should
- Examine eye constrict briskly)
movement and - shield one eye and
determine if perform test on the
defects is other see for
muscular origin consensual reaction.
or neural 3. reaction to
involvement convergence and
- To detect accommodation for
nystagmus near vision
- fix vision on a distant
and instruct to look in a
near objects.
- place fingertip in front
of the bridge of the
nose (22cm)
- then return to the far
object
- observe pupillary
reaction in both
4. examination of ocular
movement
 - observe lagging of one
or both eye ( observe
nystagmus)

Cranial Nerve Method of Testing Procedure Interpretation of results

CN V - Superficial sensory - Total loss of sensation: lesion on
Trigeminal asst. from mainly 6 ganglion or sensory root
areas (mainly light - Total sensory loss over 1 division:
touch and pain) partial lesion of ganglion or root
- Forehead and upper - Touch only lost: pontine lesion
part of the side of nose affecting sensory root
(ophthalmic) - Total sensory loss over 1 division:
- Malar and upper lip partial lesion of ganglion or root
region ( maxillary) - Touch only loss: pontine lesion
- Chin and anterior part affection sensory nucleus
of the tongue - Pain and temp lost: Dissociate
(mandibular) anesthesia ( seringobulbia)

Corneal Reflex
- Using cotton piece the - No closure: ophthalmic division of
cornea is tested the facial nerve
- Normal response is a - In bells palsy there is failure to close
bilateral blink on the affected side.
 - No response in either lid when abn.
Is tested and bilateral blink when
normal is tested: V nerve lesion
- No response on the affected side
whichever side is tested : VII nerve
lesion.
Motor assessment
- Muscles of mastication Common cause
- Have patient bite - Tumor of the base of the skull
against resistance - Chronic meningeal lesion
- Have patient protrude - Trigeminal sensory neuropathy
mandible against - Acoustic neuroma
resistance - Syringomyelia
- Have patient go into - Multiple sclerosis
lateral excursive
movements against
resistance
- Jaw jerk
Cranial Nerve Procedure Interpretation of results
CN VII Purpose of the test: Common causes of facial paralysis
Facial - To detect any - Neoplasm affecting thalamus:
unilateral or bilateral unilateral emotional paralysis
weakness of facial - Parkinsonism: bilateral emotional
muscles. paralysis
- Detect impairment of - CVA neoplasm, MND: bilateral UMN
taste palsy
- Bells Palsy
Method of testing -
1. Observation
- symmetry and - Ask the patient to close
asymmetry of face the eyes, rise the
Nasolabial fold and eyebrows, blow out the
rinkle on forehead cheek, whistle ect.

Examination of the
taste
1. the primary 4 taste (
sweet, salt, sour, bitter)
can be carried out by
usig sugar, salt, vinegar
and quinine
 2. the side of the tongue
is moistened by the test
substance
3. ask the patient to
indicate taste by
pointing

Cranial Nerve Procedure Interpretation of results

VIII Purpose of the test Test of hearing
Vestibulocochlear - To determine any 1. evaluate if the
Auditory deafness is bilateral patient turns one ear
or unilateral towards you
- Whether deafness is 2. evaluate hearing
due disease of using a ticking watch,
midline ear or rub fingers together,
cochlear nerve whisper.
- To determine the
disturbance of Rinne’s Test
vestibular functions 1. strike tuning fork - In middle ear deafness – the note
gently, hold it near is not heard
one external meatus
and ask patient if he - In nerve deafness- air and bone
can hear it. conduction are reduced but air
2. place it on the remains better.
mastoid, ask if he can
still hear it and instruct
him to say “NOW”
when sound ceases
and keep it on the
external meatus again
(normally note is still
audible)

Weber’s Test
1. tuning fork is place - In nerve deafness the sound
on the vertex appear to be heard on the normal
2. ask the patient if he ear
can hear the sound all - On chronic middle ear disease it is
over in both ears or in conducted to the abnormal ear
one ear.

Test of Vestibular
Function
1. observe equilibrium
as patient walks or
stands
 2. observe abnormal
eye movements
Ask for dizziness,
falling, nausea and
vomiting

Cranial Nerve Method of Testing Procedure Interpretation of results

CN IX 1. notice the pitch 1. ask the patient to Normally, palate should move symmetrically
Glossopharyngeal and quality of the open his mouth wide upwards and backwards, the uvula in midline
voice, cough, after a few movement and two
CN X difficulty in ask to say “AH” while
Vagus swallowing saliva. breathing out and Common cause of lesion:
sides of the pharynx “UGH’ wile in - Poliomyelitis
( both CN 9 and contract - Syringobulbia
10 are tested symmetrically - Posterior fossa tumor
together) - Advance parkinsonism
- Myasthenia Gravis
- Enlarged cervical glands
- Surgical operation of the neck
Cranial Nerve Procedure Interpretation of results
CN XI Purpose of the test - Shrugging of shoulders Common cause
Accessory - To detect wasting - Resisting the head - MND
and weakness, when turning on the - Poliomyelitis
unilateral or side - Polyneuropathy
bilateral of the - Trauma in the neck or base of the
muscles skull
- Tumor at jugular foramen
- Syringomyelia

Cranial Nerve Purpose of the test Procedure Interpretation of results

XII 1. to inspect the 1. ask the patient to Common lesions
Hypoglossal surface of the tongue protrude the tongue - Syringomyelia
2. to detect wasting, for - Poliomyelitis
weakness and - reduction in the size - MND
involuntary of affected side - Profound hemiplegia
movements. - excessive ridging and - ALS
3. to examine wrinkling
voluntary muscle - restricted protrusion
control - deviation towards one
side.
 CRANIAL NERVE TEST
Pure Motor Pure Sensory Mixed
IV Trochlear I Olfactory III Oculomotor
VI Abducent II Optic V Trigeminal
XI Accessory VIII Auditory VII Facial
XII Hypoglossal IX Glossopharyngeal
X Vagus
 Test Procedure Positive Result
Patrick’s Test or Faber Test 1.
- Evaluate the pathology of
the hip joint or the
sacroiliac joint.
Anvil’s Test 1. patient in supine position.
- Determine if there is hip 2. examiner flexes patient’s leg
pathology, for example, straight to 30°
hip arthritis, femoral 3. examiner applies gentle axis
neck/ head fracture or compression to the leg (compressing
infection hip joint)
4. examiner finally strikes the patients
heel
Trendelenburg’s Test 1. Patient stands, examiner instructs
- Found in people with the patient to stand on one leg and
weak or paralyzed observes the iliac crest bilaterally.
abductor muscles of the Normally, when one leg is lifter, iliac
hip, particularly gluteus crest should stay level.
medius and minus, dt Test is repeated on other leg.
conditions such as
osteoarthritis of the hip
or hip fracture or
dislocation.
Straight Leg Test
Gaenslen’s Test
Thomas Test